Floaters - Differential Diagnosis Framework What? Vitreous Floaters: • Microscopic collagen fibers within the vitreous that tend to clump and cast shadows on the retina, appearing as floaters to the patient. • Acute-onset flashes and floaters with visual field defect are suggestive of retinal detachment. Described by Patients As: • Black spots or specks in the vision • Spots in the eyes • Straight and curved lines • Cobwebs • Strings • "O" or "C"-shaped blobs Retinal Detachment: Symptoms: Sudden • Unilateral flashing lights • Floaters Risk factors for floaters: • Myopia • Cataract surgery • Retinal lattice degeneration • Retinal breaks • Positive family history • Have had inflammation (swelling) inside the eye Flashes DDX: Ophthalmic: • Posterior vitreous detachment • Retinal tear/hole • Retinal detachment • Optic neuritis - photopsia on eye movement, retrobulbar pain Non-Ophthalmic: • Migraine - scintillating scotomas, colored lights, bilateral, evolves over 5 to 30 minutes before resolving with onset of a headache, normal visual acuity • Postural hypotension - bilateral temporary dimming of vision and light-headedness • Occipital tumors/Occipital lobe disorders • Vertebrobasilar transient ischemic attacks Floaters DDX: Ophthalmic: • Vitreous syneresis • Vitreous hemorrhage • Posterior vitreous detachment • Retinal detachment • Vitritis • Tear film debris • With time the vitreous, begins to liquify (Vitreous syneresis) and contract. • As the vitreous contracts, it peels away from the retina (posterior vitreous detachment) • 50% of 65-year-olds will have a PVD in one or both eyes. • A person developing a PVD in one eye is likely to develop a PVD in the other eye within the following 18 months. • Sometimes, as the vitreous pulls away from the retina, a retinal tear or detachment may occur. #Floaters #Differential #Diagnosis #Ocular #ophthalmology
